150 South Palm Avenue
Rialto, CA 92376
Main Phone: 909-820-2525
www.rialtoca.gov
Organization’s Legal Name:
Physical Address:
Mailing Address:
(if different from physical)
Contact Person #1:
Phone: Extension:
Email:
Contact Person #2:
Phone: Extension:
Email:
VENDOR DEMOGRAPHICS FORM
PLEASE ATTACH W9 TO THIS FORM.
Thank you.
Smartspace Enterprises Inc. DBA, Smartspace Solutions
Tim Lujan
925-639-8347
Shane Chang
[email protected]
916-416-4591
[email protected]
2964 Southcreek Drive Lincoln CA 95648